10.1.1 ALCOHOL DEPENDENCE SYNDROME

A disorder characterised by the need to take large daily amounts of alcohol for adequate functioning

Causes

• Genetic
• Social and environmental factors including availability
• Stress, peer pressure
• Personality disorders

Clinical features

• Physical: trauma, peptic ulceration, damage to liver and pancreas, hypertension, alcoholic cardiomyopathy, alcohol foetal syndrome, alcohol withdrawal fits, tremors

• Psychological: alcohol intoxication, delirium, dementia, alcoholic hallucinosis

• Social: loss of job, marriage, friends

Differential diagnosis

• Abuse of other psychoactive substances
• Depression

Investigations

Blood: haemogram

- shows elevated mean corpuscular volume

Social investigations

Management
HC2

Treat any presenting physical or psychiatric problem
Counselling - must be on going
Psychosocial rehabilitation

Prevention

• Health education on dangers of alcohol abuse
• Reduce accessibility to alcohol

10.1.2 DRUG and SUBSTANCE ABUSE

A state arising from the repeated administration of a drug or other substance of abuse on a periodic or continuous basis leading to physical, social or occupational problems

Cause

Social factors:

• Peer pressure
• Idleness/unemployment
• Social pressures
• Poverty
• Cultural use
• Increased availability

Psychological factors:

• Other psychiatric disorders eg. anxiety, depression
• Stress
• Adolescent development changes

Commonly abused drugs

• Alcohol, see p191
• Tobacco
• Cannabis (njaga, bhangi, marijuana)
• Khat (mairungi)
• Heroin
• Cocaine
• Petrol fumes
• Organic solvents (eg. thinners)
• Pethidine
• Amphetamines (eg. speed)
• Mandrax® (methaqualone)

Presenting features

• Change in behaviour, eg. excessive irritability
• Change in function, eg. decline in school/work performance
• Loss of interest
• Episodes of intoxication eg. slurred speech, staggering gait
• Involvement in illegal activities, eg. rape, theft
• Change in appearance eg. weight loss, red eyes, puffy face, unkempt, untidy
• Financial difficulties, eg. stealing, unpaid debts
• Relationship problems eg. increased conflicts, communication breakdown

Management
HC2

Psychosocial therapy (counselling)
Treat presenting symptoms, eg. delirium, see p197
If necessary, refer to higher level for detoxification

Prevention

• Health education on dangers of drug abuse
• Employment/recreational opportunities
• Encourage social and cultural values
• Attempt to reduce availability of drugs of abuse in the community